【摘要】 目的：探讨血红蛋白与血肌酐比值（hemoglobin to serum creatinine ratio,Hb/SCr）对ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）术后3年全因死亡的预测价值。方法：回顾性选取2016年6月至2020年6月在甘肃省人民医院心血管内科成功完成首次PCI的STEMI患者687例，根据术后3年内生存情况分为生存组和死亡组。采用Cox回归分析STEMI患者发生全因死亡的影响因素，绘制受试者工作特征（ROC）曲线评估Hb/SCr对STEMI患者PCI术后全因死亡的预测价值，并通过Kaplan-Meier生存曲线比较不同水平Hb/SCr的STEMI患者随访过程中累积生存率的差异。结果：共663例（96.51%）成功完成随访，中位随访37(25,50)个月期间，41例（6.18%）发生全因死亡。多因素Cox回归分析结果显示，年龄（HR=1.086,95%CI:1.037～1.137,P=0.000），体重指数（HR=1.195,95%CI:1.128～1.266,P=0.000），空腹血糖（HR=1.069,95%CI:1.007～1.135,P=0.030），纤维蛋白原（HR=1.418,95%CI:1.120～1.795,P=0.004），心肌梗死溶栓治疗临床试验（TIMI）血流分级1级（HR=4.968,95%CI:1.194～20.667,P=0.028）、2级（HR=3.861,95%CI:1.336～11.156,P=0.013）,Hb/SCr(HR=0.858,95%CI:0.766～0.961,P=0.008)为STEMI患者PCI术后3年全因死亡的独立影响因素。ROC曲线分析结果显示，Hb/SCr诊断PCI术后全因死亡的曲线下面积为0.721(95%CI:0.645～0.798)，灵敏度为65.9%，特异度为71.2%，最佳截断值为16.627。Kaplan-Meier生存曲线分析结果显示，Hb/SCr<16.627的患者生存率明显低于Hb/SCr≥16.627的患者（log-rank P=0.000）。结论：Hb/SCr是STEMI患者PCI术后3年全因死亡的独立影响因素，且对全因死亡具有一定预测价值。更多还原

【Abstract】 Objectives: To investigate the predictive value of the hemoglobin to serum creatinine ratio(Hb/SCr) for all-cause mortality within 3 years after percutaneous coronary intervention(PCI) in patients with ST-segment elevation myocardial infarction(STEMI).Methods: A total of 687 STEMI patients who successfully underwent the first PCI at the Department of Cardiology, Gansu Provincial People’s Hospital, from June 2016 to June 2020 were retrospectively enrolled. Patients were divided into survival and non-survival groups according to their vital status at 3 years post-PCI. Cox regression analysis was performed to identify predictive factors of all-cause mortality. Receiver operating characteristic(ROC) curves were constructed to evaluate the predictive value of Hb/SCr for all-cause mortality, and Kaplan-Meier survival curves were used to compare cumulative survival rates between subgroups stratified by Hb/SCr levels.Results: The median follow-up duration was 37(25, 50) months. Among the 663 patients(96.51%) with complete followup data, 41 cases(6.18%) experiencing all-cause death. Multivariable Cox regression analysis revealed that age(HR=1.086, 95%CI: 1.037-1.137, P=0.000), body mass index(HR=1.195, 95%CI: 1.128-1.266, P=0.000), fasting blood glucose(HR=1.069, 95%CI: 1.007-1.135, P=0.030), fibrinogen(HR=1.418, 95%CI: 1.120-1.795, P=0.004), TIMI flow grade 1(HR=4.968, 95%CI:1.194-20.667, P=0.028), TIMI flow grade 2(HR=3.861, 95%CI: 1.336-11.156, P=0.013), and Hb/SCr(HR=0.858, 95%CI: 0.766-0.961, P=0.008) were the independent predictors of all-cause mortality. ROC curve analysis demonstrated that the area under the curve(AUC) of Hb/SCr was 0.721(95%CI: 0.645-0.798) for predicting all-cause mortality, with a sensitivity of 65.9% and specificity of 71.2%, at the optimal cut-off value of 16.627. Kaplan-Meier analysis showed that patients with Hb/SCr <16.627 had significantly lower survival rates than those with Hb/SCr ≥16.627(log-rank P=0.000).Conclusions: Hb/SCr is an independent predictor of 3-year all-cause mortality in STEMI patients after PCI and this indicator could be used as risk stratification parameter and patients with lower Hb/SCr might benefit comprehensive postPCI management to improve their outcome.更多还原